Volume 13
Number 4
Oct 2009
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Review
CMP Buysse, lCAC vermunt, H Raat, JA Hazelzet, WCJ Hop, EMWJ Utens, KFM Joosten

Objective: to evaluate long-term physical and psychological outcomes in patients who survived meningococcal septic shock (MSS) in childhood. Search strategy: all patients with septic shock and purpura requiring intensive care treatment between 1988 and 2001. At follow-up physical health status was assessed with a standard medical interview and physical examination; validated assess- ment procedures were used to measure behavioural and emotional problems, cognitive functioning, general health status and health-re- lated quality of life (HR-QoL). Summary of findings: 120 patients (response rate 71%) visited the follow-up clinic (age PICU admission 3.1 years; follow-up interval 9.8 years; age follow-up 14.5 years (all medians). 48% had skin scarring, ranging from barely visible to extremely disfiguring. 14% suffered from orthopaedic sequelae (amputation/s, limb-length discrepancy) resulting in important long-term morbidity. One third showed neurological sequelae: severe mental retardation with epilepsy (3%), hearing loss (2%), chronic headache (28%) or fo- cal neurological signs such as paresis of one arm (6%). Patients reported impaired general health status as measured by Health Utilities Index mark 2 and 3. Significantly impaired HR-QoL was found in the physical domains (physical functioning, general health perception). Intellectual functioning was comparable to the reference groups, whereas neuropsychological functioning in children was poorer. Patients showed similar levels of behavioural and emotional problems compared with reference groups. Adverse physical and psychological out- come variables were not associated with one another. Conclusions: patients who survived MSS in childhood mainly had mild to severe adverse physical outcome. There were no associations between adverse physical and psychological outcomes.


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